HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INqb MUST IfE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: G Permit Number:
_.µ _.. . Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: �,�.{�
EMENTA'LRCATION:
PR®�P,�O�SED INPR®U ' �r� ,_
Address: 60 V1 4ta,
11
Legal Description: QGpq i✓` 2�� SCL.)4, ' lu.G!SA-c V-, h �---
Property Tax ID#: J�l / nr7 O 0 Z Q Q Q S Lot No.
Site Plan Name: R i`1,��' �P�y^ Block No. r
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEQ LED
*Ell LION OF VI%O K:
44 >
C:0 �STIZlJCT10. EN�FOR' A CON:
Additional work to be pertormed under this permit-check all t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
ElectricPlumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ -70 Utilities: —Sewer _Septic Building Height:
0 _
Ni CO:NCTOR':.
Name �l ' VM O _ VJ C,2 �, ame:
Address: �3� /3cZ V 0 k!nQ U�-t.'�- Company: /r�V`►^Q DJ (J)L)Ms,tis /�-C
city: <o i"t o d I ll State:'�L Address: /2 Z S
Zip Code: � ( 0 Fax: City: p� L State:
Phone No. �7 7 ,3 7 /JS��� Zip Code: Vy V/ Fax:
E-Mail: Phone No '77 7-J
Fill in fee simple Title Holder on next page (if different E-Mail ry OIJT Ck
from the Owner listed above) State or County License -H-6 6 -75-/,S---
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5 p . � :a f�,.0� N�'�� G�TI,Q.N� � � +Vlf• ` ' ��. R� ��' , � . ,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City:----- -- - - - --- State: - City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improveme is your property. A Notice of Commencement must be recorded and posted on the jobsite
before -h it Inspection. If you intend to obtain financing, consult with len o n attorney before
comme ork optecording.your Notice of Commencement. let
Sign a Owner/Lessee/Contractor as Agent for Owner Signat o ontractor/Liceke Holder
S TE OF FLORIDA r STATE OF FLORIDA LU COUNTYOFCOUNTY OF C�e
The forgoing instrument v(as acknowled efore me The or in ins ent was acknowled a efore me
this�ay of � 20y thisay of 20by
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of l4oAary Public-State of Florida) (Signature of q6tary Public-State of Florida )
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
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DATE
RECEIVED
DATE
COMPLETED
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